Sugammadex for the Reversal of Rocuronium-Induced Neuromuscular Blockade in Surgical Patients: A Review of Clinical Effectiveness

Key Message

Three systematic reviews and seven randomized controlled trials were identified regarding the comparative clinical effectiveness of sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular block. The evidence consisted of low- to high-quality studies conducted in adult and pediatric patients undergoing various surgical procedures using multiple different dose combinations for rocuronium, sugammadex, atropine, and glycopyrrolate. Low- to high-quality evidence suggested that sugammadex was associated with a faster time to recovery of neuromuscular block in adult and pediatric patients compared with patients treated with neostigmine. There was also limited evidence of variable quality to suggest that sugammadex was associated with a lower overall risk of adverse events, fewer post-operative pulmonary complications, fewer post-operative abnormalities on chest radiographs, and fewer cases of tachycardia in compared to those treated with neostigmine.There was evidence of variable quality that demonstrated mixed findings (i.e., some evidence of a beneficial effect of sugammadex, and some evidence of no difference between reversal agents) for the following outcomes: residual neuromuscular block, time to extubation, post-operative nausea and vomiting, dry mouth, bradycardia, and duration of stay in the post-operative anesthesia unit. There was also limited evidence of low- to high-quality to suggest that sugammadex made no difference compared to neostigmine with regards to post-operative recurarization, the overall quality of recovery, the incidence of pneumonia or lung atelectasis, composite serious adverse events, the need for mechanical ventilation, the risk of bronchospasm, or cases of respiratory depression. One moderate-quality study suggested that a higher proportion of patients treated with sugammadex experienced hypoxemia compared to those treated with neostigmine. For the most part, heterogeneous evidence suggests that the clinical effectiveness of rocuronium with sugammadex was better or no different compared with rocuronium and neostigmine. However, there was one adverse event that was higher in patients treated with sugammadex compared to neostigmine.